Hello
@martindt1606 and
@Proud to be erratic.
So a quick update.
I’m using Levemir long acting insulin 18(AM) and 20 (PM).
I’m also using NovoRapid short acting insulin 7/6/6. This is until I’m used to carb counting.
I was started on Levermir and NR. I don't remember my doses, but they were in the same sort of range. My DSN after my discharge saw my photos of my logbook (pre Libre for me, so all manual recording) and she steadily adjusted my doses. All done by email. The process was pretty crude and not too successful - I yo-yo'd from hypo to hyper, with hypos sometimes very deep and long lasting; but I did learn that while hypos were most unpleasant experiences I survived, felt the JBs bringing me back into an acceptable state and overall reduced my anxiety and fear about being low.
Despite Creon, I came to realise that I wasn't fully digesting my food and it took nearly 2 years for a Gastroenterologist to diagnose an unusual bacterial infection that was causing the malabsorption. Antibiotics sorted that out in Nov 21. Thereafter carb counting started to relate to bolus dosing and that relationship became increasingly apparent on my Libre.
I’ve done the Bertie online course.
Yes I did that; but also by then I had also found Gary Scheiner's book "Think Like a Pancreas". I found his explanation of and guidance for carb counting helpful. The bit I didn't grasp properly then was the effect of exercise and activity. So a number of subsequent hypos were solely because I had not reduced my bolus enough for the activity that I was doing by then.
These days, with nearly 4 yrs under my belt, I still calculate my carbs as accurately as I reasonably can but then relax in the conversion to units of bolus. Since I can be applying a reduction of 50% to account for activity, that is just one step in guestimating my insulin needed. [Guestimating because how punishing was 4 hrs of gardening? Its not something easily quantified.] If my BG is high when I need to bolus for the coming meal I have to add a correction and that becomes a further guestimate in itself; my personal natural insulin resistance seems to increase markedly when my BG is above c.9 and certainly 10. Also, but not the last consideration, different types of meals digest at different rates, sometimes needing me to split bolus doses: a bit before as a pre-bolus and a bit later (2 or 3 hrs later) as the digestion finally gets going fully.
Before CGM this would have been really tricky to contemplate. But now it's much more manageable and allow much more flexibility. I often start my evening meal undecided about whether to have a desert - but can add a 2nd bolus if I do decide to eat more. All easy enough even without CGM. But now I can start a meal and from what my CGM is telling me I can decide to just change what I'd originally planned - either way. I am increasingly appreciating being informed about my meal choices by my CGM and making subsequent bolus decisions accordingly.
I’ve also got a Libre2 in situ. I’m aware of the pumps but been told to get used to the basics before they will consider prescribing this.
I got Libre 2 after 12 months in Feb 21. I'm attaching below a link to the limitations of CGM, which I found most helpful in clarifying to me why what I was expecting didn't always appear.
Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk
Despite knowing these limitations I still get periods when my readings, graphs and trends just don't make sense! This is not because the CGM is wrong - it's just because, for me, diabetes is not playing within the rules as I understand those rules!
Although I’ve only just become diabetic I was suffering with pancreatic insufficiency prior to removal of my pancreas. So I’ve been using Creon for a while.
I think getting the Creon level right is important to ensure full digestion and absorption of all food - then bolus calculatng has more sense. But there is still plenty of guestimating!
I had a Total pancreatectomy islet auto transplant. So the whole pancreas has gone.
As already said do ask questions if you need to. Having absolutely no panc'y is, in my opinion really quite complex. Your former panc'y provided many functions. How much were remaining before your Whipples is probably not known and so how much you'd already adjusted to having missing pancreatic functionality will become clear in due course.
Good luck.
